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.. 5 <br /> 04 <br /> BUSINESS CERTIFICATE#06 'G& <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE /n O(e <br /> Expiration Date: December 31, 2010 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> �7� DBA i r /" ,q/ is conducted at <br /> Business Location: M(t y� I?e e kek r4lC� <br /> Business Mailing Address: / td`� <br /> Business Type:a'ety-, ✓/ Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: ,ry D — 6 72 C16 <br /> Admicertify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> es as required under law. <br /> *Signature of au d agent *Signature of authorized agent <br /> 0/ L 6to-00357- <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> / In case of emergency 5p� • (o�g aa,5 b <br /> NAME: TELEPHONE NUMBER: sOS' S�/� Z 57 7 <br /> Alarm Company: /I/0 J L/ <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss //_� [ DATE /0 'S"06 <br /> Personally appeared before me the above-named Cle'R V f t �1v n and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> led <br /> Margaret C. Santos <br /> ° NOTARY PUBLIC Notary Public <br /> SEAL i Commonwealth of.Massachusetts <br /> Ny Commission Expires Sept.24,2010 9-0 I{ -Dol -O <br /> Commission Expires: <br />